St Vincent’s Regional Teaching
Emergency Medicine not in the Textbook
It was a pleasure to host the regional emergency teaching. Through lockdown restrictions and failing audiovisual technology we were able to put up a program together that we are proud of. The recordings of the key sessions can be viewed below with additional resources at the bottom of the page. We developed a program designed to teach important and interesting facets of emergency medicine that you won’t find in Dunn, Tintinalli or Cameron. Together, we drew the expertise out of our world class speakers and educators. Yes, it was an absolute treat.
Enjoy
Alex Handrinos
Q&A Challenging Patient Panel
This session explored our expert’s knowledge in a range of controversial topics including the management of custodial patients, hunger strikes, GHB withdrawal and forensic medicine. Turn your volume up, sorry to say the audio wasn’t captured so well in this recording.
Expert Panel
Dr Sarah Ward
FACEM, Medical Specialist at the Coroner’s Court
Associate Professor Nicola Cunningham
FACEM, Senior Forensic Physician
Dr Martyn Lloyd Jones
Addiction Medicine Specialist
Case 2.
A 24 year old male is brought in by ambulance from prison. He was incarcerated three days ago during which time he has become increasingly agitated, tremulous and at times, non-responsive. Prior to being incarcerated he was known to use 50mls per day of GHB. He had no other known medical history.
On arrival he was intermittently snoring which resolved with simple airway manoeuvres. He did not tolerate any airway adjuncts. He was acutely agitated, diaphoretic and tremulous. His GCS was 10 (E2,V3,M5). His pupils 3mm and reactive. The rest of his neurological assessment was normal. He had a small haematoma on his head from one of several falls he has had over the past few days.
His agitation proved to be obstructive to medical care, despite judicious use of benzodiazepines. He was uneventfully intubated to facilitate a CT brain which was subsequently normal. His diagnosis was GHB withdrawal
Case 4.
A 45 year old man is brought in by ambulance to ED, intoxicated with alcohol. He was found lying in a gutter and a bystander called an ambulance. He has an acute abrasion to his forehead. How this head injury occurred is unknown.
You know him well, as does the rest of the department from his many alcohol related presentations. This is the 8th presentation this month with intoxication. He often hits his head, sometimes he has a CT brain and is discharged when safely mobilising.
He has a history of not engaging with addiction medicine teams or community supports..
Case 1.
A 23 yo woman attends the ED with her friends at 3am reporting that she may have had non-consensual sex and is worried that her drink was ‘spiked’. The group had been at a nightclub when she became separated from her friends. The friends used ‘find my iphone’ and found her at another person’s apartment.
She can’t remember leaving the nightclub and the next memory she has is of being with her friends in an uber.
She thinks that she has had non-consensual intercourse at this apartment and is now distressed that she might have been given drugs. She wants to take a drug test.
On examination, she appears intoxicated with alcohol and had in fact been drinking heavily at the nightclub.
She is distressed but cooperative.
Case 3.
A 50-year-old prisoner is brought to the ED with dehydration. He is in his fourth week of a hunger strike in which he is protesting his current prison conditions. During this time he reports not eating any solid foods, drinking three cups of black coffee per day.
The prison medical staff became concerned with his vital signs and the patient agreed to come to hospital.
He is alert and oriented. He is tachycardic, 140bpm, BP 85/40 and appears very dehydrated. His sodium in 160.
The patient is happy for you to examine him and conduct investigations, but he is refusing any fluids or other treatment.
Shoulder guru, Dr Neil Cunningham discussed his approach to the patient with a dislocated shoulder. But surprise, it doesn't always include his eponymous technique.
As an emergency doctor you will likely be called to attend a court hearing. This is often anxiety provoking due to the unfamiliar environment, processes and expectations. Based on years of experience, Nicola demystifies this process and gives her top tips for attending court.
What is the role and process of the coroner’s court? It might surprise you.
And what we can learn from the investigation of death?
A powerful presentation from our brilliant speaker, Georgina, who updates us on the current struggles of our friends and emergency colleagues in Myanmar.
